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1. Vicarious Trauma andStress Management Identification and Ethical Intervention
Anna M. Whalley, LCSW
Shelby County Crime Victims Center
901.545.4357
2. Primary PTSD Individuals who have experienced, witnessed or were confronted with a traumatic event and responded with intense fear, horror or helplessness.
3. Post Trauma Responses- Physical Difficulty falling asleep or staying asleep
Nightmares
Restlessness
Headaches
Change in appetite
Decreased libido
4. Post Trauma Responses- Emotional Difficulty concentrating or making decisions
Grief
Moodiness
Easily startled
Guilt
Numbness
Depression
5. Description or Disorder? Labeling a normal reaction?
Small percent develop PTSD
Small percent develop secondary PTSD
Rose Simering, PhD, James Munroe, EdD, Stacy Bird Gulliver, PhD
6. Secondary Trauma Indirect exposure to trauma through a firsthand account or narrative of a traumatic event.
7. Why talk about ethics? Impact on clients
Impact on practitioner
Impact on agency practice
Impact on funding/budgeting
Impact on clients
8. Consequences Disruptions in the relationship with the victim
Conflict with professional colleagues
Violations of boundaries
Herman, 1992
9. Consequences The worker may push victims too quickly in an effort to master their own responses.
10. Consequences The “silencing response”
This will hurt the client or me.
This cannot be true.
If this happened to you, it could happen to me.
Anna Baranowsky, 1997
11. Possible Ethical Consequences Less than desirable services to victims
Staff friction and disruption
Poorly thought out program decisions
Straying from agency mission
12. Possible Correlates to Secondary PTSD Personal trauma history
Large number of survivors in caseload
Insufficient training
13. Correlates, cont. Identification with victims
Insufficient support in the workplace
Insufficient social and familial support
14. Compassion Fatigue “The convergence of post traumatic stress, secondary traumatic stress and cumulative stress/burnout in the lives of helping professionals and other care providers.”
Figley, 1995
15. Compassion Fatigue Intrusive thoughts or images
Difficulty separating work from personal life
Lowered frustration tolerance/anger outbursts
Gentry, Baranowsky and Dunning
16. Compassion Fatigue Dread of working with certain clients
Depression
“Assumptive world” disturbances
Hypervigilance
17. Compassion Fatigue Self destructive self-soothing behaviors
Diminished sense of purpose with career
Decreased functioning in non-work situations
Chronic lateness
18. Compassion Fatigue Frequent headaches
Exhaustion
Gastrointestinal complaints
Increased irritability
Lowered self-esteem
Workaholism
19. Chronic Responsibility Syndrome “I can do it better, so I better do it.”
“It won’t be done if I don’t do it.”
Say “No.”
Delegate and Train
Take a Sabbatical
20. Who is at risk? Professionals, family members, friends and associates of trauma survivors
Victim assistance specialists, psychologists, social workers, lawyers, disaster workers, nurses, doctors, care givers, clergy
21. Prevention- The Ethical Course Secondary stress is predictable.
Secondary stress is damaging.
Secondary stress “rolls uphill.”
Mandate to do no avoidable harm
22. Prevention Professional strategies
Balancing caseloads
Accessible supervision
Pearlman and Saakvitne, 1995
23. Prevention Organizational Strategies
Sufficient release time
Safe physical space
24. Prevention Personal strategies
Respecting one’s limits
Maintaining time for self care
25. Prevention General Coping Strategies
Self-nurturing activities
Seeking connection
26. Predictors of Effective Trauma Workers Mentally healthy
Interact in positive ways with colleagues
Flexible and ready for the unexpected
Mindful of nonverbal actions
Take care of themselves
Rosemary Thompson, 2003
27. Self Awareness and Care- Post Crisis Know your “triggers.”
Stay aware of your own issues.
Be human and allow yourself to grieve.
Maintain realistic expectations about work.
28. Ask for and accept help from other professionals. Build a healthy support group.
Seek the inputs of others who remain healthy.
Delegate responsibilities.
Remember that you learn from the experience.
29. Live a healthy , balanced life. Eat good foods.
Set and keep healthy work boundaries.
Take time to exercise, rest, meditate or pray.
Develop and reward your sense of humor.
Avoid chaos.
30. “Don’ts” Don’t make big decisions.
Don’t blame others.
Don’t spend energy complaining.
Don’t try a quick fix.
31. Ethical Supervision Don’t teach what you don’t know.
Admit your limitations.
Follow your own guidelines.
Follow the Code of Ethics.
Remember to remember.
32. The Road Back Home Sense of well-being, comfort, purpose, identity and empowerment
Gentry, Baranowsky and Dunning
33. Task One Assess and Evaluate
Symptoms being experienced by the professional
Events of professional and personal life which have contributed to these symptoms
34. Assess- Personal Past victimization
Personal values and attitudes
Need for control
Personality
Residual stress level
General health
35. Assess- Organizational Work overload
Threat of funding cuts
Job conflicts/confusion
Interpersonal conflicts
Insufficient resources
Supervisor’s attitudes
Organizational changes
36. Task Two Personal and Professional Time-Line
Develop a narrative of what brought you to this point
Safe place visualization
Reconnecting with hope and empowerment
37. Task Three Reframing and Reprocessing
Professional goals
Personal goals
Primary and secondary trauma
Triggers
Self-regulation
38. Task Four Supervising the self
Develop the idea of the Great Supervisor
Omni-benevolent
Omniscient
Says only the
best
Identify needed skills and self soothing areas
39. Task Five Practice, practice, practice!
Remain aware of personal reactions
Guide oneself gently back
Process reactions with supervisor and/or peers
40. Celebrate your successes! Remember the 80% rule.
Remember the calls that you never get.
Remember that your time, skills and care are the greatest gifts you can give.